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Gulf War Review GULF VETS Gulf War Review Vol. 12, No. 1 Information for Veterans Who Served in Desert Shield/Storm November 2003 New VA Study Supports Gulf War Service- Exercise/Behavioral Therapy Helps Gulf War ALS Link Veterans A recent scientifi c study supports a 22-month A Department of Veterans Affairs-sponsored study policy by the Department of Veterans Affairs (VA) to to determine if aerobic activity and chronic behavior recognize amyotrophic lateral sclerosis (ALS) among therapy (CBT) could improve the symptoms of Gulf veterans of the Gulf War as a service-connected War veterans found that modest relief for some of the illness. symptoms in physical and mental health functions, but “Based upon preliminary research available in no improvements in pain symptoms. CBT is a widely December 2001, I felt it was appropriate for us to act used technique for bringing some relief to patients with swiftly,” said Secretary of Veterans Affairs Anthony otherwise diffi cult to treat symptoms. J. Principi. “I’m gratifi ed that the fi nal study supports Researchers from the Boston VA Medical Center, that decision.” ALS, or Lou Gehrig’s disease, kills the University of Michigan, and the Walter Reed cells in the brain and spinal cord that control muscle Army Medical Center led the study, a randomized trial movement, resulting in gradual wasting of the muscles. conducted at 18 VA medical centers and two military Fatal in most cases, the disease usually strikes people hospitals from April 1999 to September 2001. between ages 40 and 70 years of age. The cause of the The randomized study included 1,092 patients who disease is unknown. suffered from at least two chronic symptoms present The recent study found that veterans who were among many Gulf War veterans: fatigue that limits deployed to the combat theater during the Gulf War (Continued on page 2) were nearly twice as likely to develop the disease as veterans not deployed to the Gulf. Forty cases Also in This Issue were identifi ed among Gulf War veterans. Based on Studies Confi rm Poorer Cognitive Performance in comparison to non-deployed Gulf War era veterans, 33 Gulf War Veterans…...…….….......….…...….…......2 cases were expected in this group. Therefore, seven Dep. Under Secretary for Health Perlin Testifi es additional cases were found among approximately 700,000 Gulf War veterans. The incidence of ALS Before Congress on Pre- and Post-Combat was especially high among deployed Air Force Deployment Health Issues…..…..……………....…..3 personnel, who were 2.7 times more likely to develop GAO Questions DoD Plume Modeling……………..6 ALS than non-deployed Air Force personnel. Research Advisory Committee Continue to Meet “Earlier research did not provide a defi nitive Regularly ..………...….….…...….…..…...….…......7 answer to this issue,” said lead author Ronnie D. Horner, Ph.D. Horner was with VA’s Epidemiologic NAS/IOM Gulf War Ongoing Health and Research and Information Center in Durham, NC, Environmental Exposure Assessments ...….….....….7 when the research was conducted, and is now with About the “Review”....…………..................…......…8 the National Institute of Neurological Disorders and Stroke of the National Institute of Health. “We now VA Publishes Brochure for Operation Iraqi have compelling evidence that service in the Gulf is Freedom Veterans and Their Families...……...…....8 associated with the occurrence of ALS among veterans Address Changes and Duplicates....……...…..…….9 of the ’90-‘91 Gulf War.” The study, published in the September 23, 2003, issue of the scientifi c journal Gulf War Health Registry Examination Statistics....9 Neurology and funded by VA and the Department Q’s and A’s - New Information Regarding Birth of Defense (DoD), does not identify a cause for the Defects.......……….......……………………...…....10 disease or the increased occurrence in this group of Where to Get Help……………....……….…..……11 veterans. (Continued on page 2) 1 Department of Veterans Affairs New VA Study Supports Gulf War Service- Drawbacks of the study included noncompliant ALS Link (Continued from page 1) patients (patients dropping out of the study), including The ALS Association and researchers from the an average of only 50% attendance of the 12 weekly Centers for Disease Control and Prevention advised the therapy sessions. Patients who attended more than study leaders. Numerous medical, academic, veterans eight of 12 weekly sessions reported significant and voluntary health organizations provided assistance improvement in physical functioning than those who in conducting the study. attended fewer sessions. The study, “Cognitive Behavior Therapy and Another recent study by Dr. Robert W. Haley of Aerobic Exercise for Gulf War Veterans’ Illnesses: the University of Texas Southwestern Medical Center A Randomized Control Trial,” was published in the at Dallas also supports VA’s decision to officially March 19, 2003, issue of the Journal of the American recognize ALS as a service-connected illness for VA Medical Association. benefits. The above article was drafted by Julissa Cruz, a VA’s National ALS Registry senior majoring in journalism at the University of Il- Earlier this year, VA established a national ALS linois at Ubana-Champaign. Julie spent 10 weeks in registry to identify veterans with the disease -- VA's Environmental Agents Service as a summer intern regardless of when they served -- and track their health through the Hispanic Association of Colleges and status. Veterans with ALS who enroll will complete Universities (HACU) National Internship Program. an initial telephone interview covering their health and militaryservice and will be interviewed twice yearly thereafter. Studies Confirm Poorer Cognitive Performance in Gulf War Veterans For more information about VA’s ALS Registry, based at the Durham VA Medical Center, call 1- Veterans deployed to the Gulf War in 1990 and 877-DIAL-ALS (1-877-342-5257) or email. 1991 scored worse overall on neuropsychological [email protected] tests compared to non-deployed veterans in a series of studies conducted by researchers at the Department of It is important to keep in mind that ALS is a very Veterans Affairs (VA) Environmental Hazards Center. rare disease, and that 40 cases diagnosed among the The Environmental Hazards Center is part of the VA nearly 700,000 veterans who served in the theater of Boston Healthcare system. The five studies appear in operations in 1990-91 suggests that veterans are still the June 2003 issue of the Journal of Psychopathy and very unlikely to get this fatal disease. Behavioral Assessment. Exercise/Behavioral Therapy Helps Gulf War In one study, Gulf War-deployed veterans performed Veterans (Continued from page 1) significantly worse than their non-deployed cohorts on tests of attention, visuospatial skills, visual memory, usual activity, musculoskeletal pain, and/or cognitive and mood. Among the deployed veterans, those who symptoms such as memory loss or concentration reported having taken pyridstigmine bromide – a pill difficulties. given to about 250,000 Gulf War personnel to protect The study found that CBT, whether or not it was against possible attack with nerve gas – performed combined with aerobic activity, led to significant worse than those who reported not taking the pill. improvements in physical functioning after 12 months. Past research on Gulf War veterans has shown Among the patients receiving CBT, there was an that they are an increased risk for a vague cluster 18.3% increase versus the patients not receiving CBT of symptoms, sometimes called Gulf War illness, who only improved 11.6%. involving chronic fatigue, musculoskeletal problems, CBT also helped improve mental health functioning asthma, post-traumatic stress disorder, depression, and cognitive symptoms regardless of aerobic activity. memory loss, poor concentration, and other health Aerobic activity, with or without CBT, also led to problems. These problems are also diagnosed in non- improvements in mental health functioning, cognitive Gulf War veterans, although usually at lower rates. symptoms, fatigue and distress. There is still no definitive answer regarding the cause However, neither improved any pain symptoms. of these various symptoms. Theories point to stress and other psychological factors, exposure to chemical 2 or infectious agents, or other environmental toxins, or health care, unless there is sufficient medical evidence side effects of anti-nerve agent. to conclude that the illness is not attributable to that Another of the five studies showed that symptoms service. of post-traumatic stress disorder were more prevalent To date, 22 combat veterans have been transferred in Gulf-deployed veterans, and that these symptoms to VA from DoD for specialized, long-term health were associated with poorer neuropsychological care and rehabilitation. These patients have had performance. spinal cord injuries, gunshot and grenade wounds, and other combat trauma. There have been relatively According to Roberta F. White, Ph.D., collaborator few veterans of Operation Iraqi Freedom who have on four of the five articles and author of the fifth otherwise presented for care at a VA medical center – a review of existing research – there appears to be because most combatr troops are stil serving in Iraq multiple causes of Gulf War veterans’ illnesses. She or remain on active duty. The Iraqi war veterans commented, “The neuropsychological and health presenting to our clinics have had a varied range symptom sequelae of Gulf War zone service are multi- of health problems. No illness due to chemical or determined and cannot easily be explained on the biological agents have been reported. basis of simplistic models of causation.” She added, “Psychological, historical, and exposure parameters Assessment of Difficult-to-Diagnose Illnesses must be considered in the scientific evaluation of this The majority of veterans returning from combat and problem.” peacekeeping missions are able to make the transition Perlin Testifies on Pre- and Post-Deployment to civilian life with few problems. Most who come to Health Issues for care at a VA medical center because most combat troops are still serving in Iraq or remain on active duty.
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